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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Middleton, L. J. Barton, P. M. Cooper, K. G. Daniels, J. P. Tsourapas, A. Roberts, T. E. Bhattacharya, S. Champaneria, R. |
| Description | Author Affiliation: Roberts TE ( Health Economics Unit, School of Health and Population Sciences, Public Health Building, University of Birmingham, UK. T.E.Roberts@bham.ac.uk); |
| Abstract | Objective To undertake a cost effectiveness analysis comparing first and second generation endometrial ablative techniques, hysterectomy, and the levonorgestrel releasing intrauterine system (Mirena) for treating heavy menstrual bleeding. Design Model based economic evaluation with data from an individual patient data meta-analysis supplemented with cost and outcome data from published sources taking an NHS (National Health Service) perspective. A state transition (Markov) model was developed, the structure being informed by the reviews of the trials and clinical input. A subgroup analysis, one way sensitivity analysis, and probabilistic sensitivity analysis were also carried out. Population Four hypothetical cohorts of women with heavy menstrual bleeding. Interventions One of four alternative strategies: Mirena, first or second generation endometrial ablation techniques, or hysterectomy. Main outcome measures Cost effectiveness based on incremental cost per quality adjusted life year (QALY). Results Hysterectomy is the preferred strategy for the first intervention for heavy menstrual bleeding. Although hysterectomy is more expensive, it produces more QALYs relative to other remaining strategies and is likely to be considered cost effective. The incremental cost effectiveness ratio for hysterectomy compared with Mirena is £1440 (€1633, \$2350) per additional QALY. The incremental cost effectiveness ratio for hysterectomy compared with second generation ablation is £970 per additional QALY. Conclusion In light of the acceptable thresholds used by the National Institute for Health and Clinical Excellence, hysterectomy would be considered the preferred strategy for the treatment of heavy menstrual bleeding. The results concur with those of other studies but are highly sensitive to utility values used in the analysis. |
| ISSN | 09598138 |
| e-ISSN | 17561833 |
| Journal | BMJ (British Medical Journal) |
| Volume Number | 342 |
| Language | English |
| Publisher | British Medical Journal Publishing Group |
| Publisher Date | 2011-04-01 |
| Publisher Place | Great Britain (UK) |
| Access Restriction | Open |
| Subject Keyword | Contraceptive Agents, Female Administration & Dosage Endometrial Ablation Techniques Hysterectomy Levonorgestrel Menorrhagia Drug Therapy Cost-Benefit Analysis Health Resources Utilization Intrauterine Devices, Medicated Quality-Adjusted Life Years Randomized Controlled Trials As Topic Meta-Analysis Research Support, Non-U.S. Gov't Medicine |
| Content Type | Text |
| Resource Type | Article |
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